Lobbyists seek compromise in divisive health care debate

Lobbyists want compromise while each party sticks to its own plan

Apr. 10, 2013

Written by

and William Petroski

Interest groups and observers called for a third option on Wednesday in a legislative debate over state-sponsored health care that has so far focused on competing plans favored by Democrats and Republicans.

Representatives from hospitals and others in the medical field said they favored the funding mechanism included in the Democrats’ preferred plan: an expansion of the existing Medicaid program that would draw down substantial new federal dollars.

But they also lauded the innovative changes to the way the state provides health care to the poor envisioned in the alternative plan Republican Gov. Terry Branstad rolled out last week.

An ideal compromise, they said, would accept federal dollars but move away from traditional Medicaid and toward care that aims to prevent serious illnesses and pays providers for keeping patients healthy.

“We could make major reforms to our Medicaid program in a way that is meaningful and saves costs and provides quality care to the patients,” said Sabra Rosener, a lobbyist for Iowa Health System. “But it’s going to take some guts and it’s going to take some real thought and getting past whether we take the federal money or not.”

The points were raised Wednesday in a House subcommittee hearing.

Lawmakers are currently considering both plans.

Democrats favor the Medicaid expansion included in President Barack Obama’s health care reform, which would extend coverage to people making up to 138 percent of the federal poverty level. The federal government promises to pay 100 percent of the cost of that expansion for the first three years and at least 90 percent thereafter. Senate Democrats suggest 150,000 Iowans would be covered by such an expansion.

Branstad’s proposal, known as the Healthy Iowa Plan, by contrast, would cover Iowans who make up to 100 percent of the federal poverty level and encourage people who make a bit more to purchase subsidized private insurance on the government’s new insurance exchange. Participants would be expected to pay small monthly premiums, but could earn back those payments by undergoing physical exams, health-risk assessments and other measures to head off expensive illnesses.

The plan requires patients to seek care from providers working for “Accountable Care Organizations” that reimburse hospitals and doctors for keeping people well instead of just providing more tests and treatments.

But even as lobbyists were calling for compromise, partisan vitriol was in full effect Wednesday, as evidenced by Sen. Jack Hatch angrily accusing Branstad of “deceptive and dishonest” tactics in debating the issue.

In a speech from the Senate floor, Hatch, D-Des Moines, a leading proponent of expansion, strongly objected to a flier circulated in the Iowa Capitol by Branstad’s staff. The flier included a chart comparing the Republican governor’s Healthy Iowa Plan with the Senate Democrats’ plan to expand Medicaid.

The Branstad chart said the governor’s plan would cover primary care, be sustainable long-term and require participants to contribute to the cost of the program while modernizing the health care system and rewarding healthy outcomes at a cost of $23 million to the state. In contrast, the governor’s chart said the Democrats’ plan would cover primary care, but fail to address other issues and cost taxpayers $83.4 million.

Hatch called Branstad’s flier “seriously flawed from start to finish. ... He knows nothing what he is talking about.”

“Jack Hatch is angry, because he attached his health care hopes to a failed 1960s program like Medicaid while Gov. Branstad instead offers a modern health care plan that will make its patients healthier,” said Tim Albrecht, Branstad’s communications director.

The competing plans will be aired again at a public hearing at 5:30 p.m. next Tuesday in the House Chamber and in a subcommittee hearing sometime next week.